What is Elective Mutism?

Elective mutism, also known as selective mutism, is the result of a social anxiety disorder most prevalent in children younger than five years of age. Children affected by elective mutism do not have a speech or language disorder preventing them from communicating fluently; rather, they choose to remain silent in certain situations, especially social situations, such as in school or around strangers. Elective mutism may be treated through behavior therapy, or in more extreme cases, anxiety medication may be prescribed.

Elective mutism occurs when a child has a strong grasp of their native language yet in certain social situations chooses neither to speak or nor otherwise communicate in any way. Elective mutism may display itself in several ways: the child may act normally at home yet will refuse to interact with instructors and peers at school; they also may choose to speak to some trusted individuals, but not to others. To truly fulfill the diagnosis of selective mutism, symptoms must last for at least one month and include a consistent refusal to communicate in social situations. It is important to remember that elective mutism is not a type of speech disorder; this condition is not the result of a speech impediment or a lack of comprehension.

Most commonly these individuals experience an extreme social anxiety disorder and phobia of social situations, and their mutism is a display of this fear. It is estimated that perhaps three to eight children per every 10,000 may suffer from elective mutism at one point or another, but this rate may be higher since it is expected that many cases go undiagnosed. Undiagnosed cases may be because these families are isolated from potential resources that may be used to diagnose or treat them; they may consider the condition something their children may eventually grow out of, or they may merely not realize their child has a problem since this condition is most commonly seen in out-of-home situations.

Diagnosis of selective mutism involves several steps that are performed by a group of pediatricians, speech language pathologists and psychologists. First, the child will be tested for an oral communication impairment and will be screened to make certain they are not suffering from a hearing disorder. Interviews also will be completed with the parents and teachers of the child to gather specific details about the condition. Finally, a speech and language evaluation will be completed to find the level of the child’s communication skills.

Elective mutism is a difficult condition to treat. Treatment typically involves behavior therapy and usually includes the coordinated efforts of parents, therapists and the child's school. Exposure therapy, which involves gradually exposing the individual to social situations, is a common practice. In severe cases, anti depression medication or anti anxiety medication may be prescribed by a doctor.